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		<!--<h1 align="center">Reference</h1>-->
		<p id="top">1. I have read the General Information in section 3 of this form and understand that information will be disclosed in accordance with applicable legislation and information release policies (including spent convictions legislation, however described) in the Commonwealth, States and Territories;</p>
		<p>2. I understand that the position/entitlement for which I am being considered may be in a category for which exclusions from Spent Convictions legislation may apply;</p>
		<p>3. I have fully completed this form, and the personal information I have provided in it relates to me, contains my full name and all names previously used by me, and is correct;</p>
		<p>4. I acknowledge that the provision of false or misleading information is a serious offence;</p>
		<p>5. I acknowledge that the Approved Agency named in Section 1 of this form is collecting information in this Form to provide to NZ Police to provide to CrimTrac (an Agency of the Commonwealth of Australia) and the Australian Police Agencies;</p>
		<p>6. I consent to: <br />CrimTrac using and disclosing personal information about me in this form to the Australian Police Agencies;
b. the Australian Police Agencies disclosing to CrimTrac, from their records, Police History information that can be disclosed in accordance with the laws of the Commonwealth, States and Territories and in accordance with the relevant jurisdiction’s information release policies;
c. CrimTrac disclosing the information disclosed by the Australian Police Agencies to NZ Police, and
d. NZ Police disclosing any criminal history information about me to the Approved Agency named in Section 1 of this form to assess my suitability in relation to my application;</p>
<p>7. I acknowledge that any information provided by me in this form relates specifically to the purpose identified in Section 1 of this form;</p>
<p>8. I acknowledge that any information provided by the Australian Police Agencies or CrimTrac relates specifically to the purpose identified in Section 1 above;</p>
<p>9. I acknowledge that personal information that I provide in this form may be disclosed to the Approved Agency named in Section 1 of this form (including contractors or related bodies corporate) located in New Zealand or overseas; </p>
<p>10. I acknowledge that it is usual practice for an Applicant's personal information in this form to be disclosed to NZ Police and Australian Police Agencies for them to use for their respective law enforcement purposes including the investigation of any outstanding criminal offences. </p>
<p style="color: red;">Note: The information provided in this form will be used only for the purpose stated above unless statutory obligations require otherwise.</p>
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